Individual
MILLIE KOOISTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 CRAWFORD ST, TERRE HAUTE, IN 47807-4614
(812) 231-5678
(812) 231-4475
Mailing address
110 CRAWFORD ST, TERRE HAUTE, IN 47807-4614
(812) 231-5678
(812) 231-4475
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28174208A
IN
Other
Enumeration date
12/14/2016
Last updated
12/14/2016
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